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I SUPPLEMENTARY SHEET 030-30982 P'
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| Amendment No. 01 $,,
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EI Bittner Engineering, Inc.>d 113 Seuth 10th Street|| Escanaba, MI 498291
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I In accordance with letter dated July 23, 1992, License Number 21-26010-01 is amended as P
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' Item Two (Address) is changed from g t
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| Conditions 10.and18.arbmendedasfollows: <7$ |-
4 N? . J10. Licensed materiallaiay be tiie atthelicensee'sf'ai1Ttieslo'catedat113 South 10th
Street, Escanabapilchigan,'d .d ts temporary j6M[i ; Commission-maintainsshes of thflicensee anywhere in >i
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jurisdiction for9,yhere the3J$ N6 clear Regu(dthe United States a oty*
|egulating$th s'e ofd'{ cense aterial. Vd
| L-- NE D / f P p^[ihl[salicense,, thetlicensee shall<
18. Exceptasspecif}qallyprovided i pq
f,d)hg any;enclosurl5s, listed below.at'ei6ent'skrepres'entations, and >rdanh Mj
conduct its progrdni in acEp'Jdolium6ntWThe >procedures contained in 'tlisW
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NU.S. Nuclear Regulathry Const),sioiFQne ' oj)s shall gover'ii'unless the statements,d
ensee'sdpplicatioW and correspondence are k
more restrictive than t_he r'gul{ation'%j')prepresentations, and procedufes in'the(/ .tM /gj<j{ De si Wg n\, ha
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ApplicationdatedJah)uary25, 19891 and
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FOR THE U.S. NUCLEAR REGULATORY COMMISSION-| $s;
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1 * 1 INFORMATION FROM LTS.| EETWEEN: : ------------- ------
L ICENE FEE MAWEMENT E( ANCa, M M i FPC'. RAM COTE: 03121STATUE LCDE: OAND '
PEGICNAL LICFNSIN; SECTIC'6 FEE CATEGORY: 3P.
2 Erf, CATEi 19940430FEE COMMENTS:.
: EECOM IIN A55VE~EEGDT'O'~~~~~~~~~~~: : : ::::,,: :::::::::::::::::::::: 4 : : : :
LICENSE FEE 14 arf lilAL
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1. AFFLIC/< TION AITACHEDArfLICANT/LICEN5EE: 11 T tJ R E h',1 NE E R I NG . INC.RECEIVED DATE-- y .: 0 7 2 7
DDCPE1 ND: 3030982CCMIEOL NO. 393753LICENSE ND.: 21-2t010-01ACTION T1FE: APENDMENT
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3. COMMENT!
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d. C O R R E T.T F EE F AID. AF F LIC ATION M AY EF PROCEEEED FOR:AMENDMENI ...}... ... ..
LICENEE [[[[,'[[[[[[[[[
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LICENSE FEE MANAGEMENT ERANCH. ARM : PROGRAM CODE: 03121 ;f! AND STATUS CODE: 0 i ,
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REGIONAL LICENS!!iG SECTIONS : FEE CATEGORY: 3P '|' t: EXP. DATE: 19940430 2 i
FEE COMMENTS:O I DECOM FIN ASSUE ~REQDT~R~~~"~~~"" ; j':::::::::::::::::::::::::::::::::::::: + i
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LICENSE FEE TRANSMITTALn |i
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! ]1. APPLICATION ATTACHED '|(* APPLICANT / LICENSEE: BITTNER ENGINEERING, INC. '('
RECEIVED DATE: 920727 iiDOCKET NO: 3030982CONTROL NO.: 393753 LLICENSE NO.! ?!-26010-01ACTION TYPE: AMENDMENT
2. FEE ATTACHED86 'Lo ;
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3. COMMENTS
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D. LICENSE FEE MANAGEMENT BRANCH (CHECK WHEN MILESTONE 03 IS ENTERED /,,D
1. FEE CATECORY AND AMOUNT: _,,,,,,,,,,,_,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2. CORRECT FEE FAID. AFFLICATION MAY EE PROCESSED FOR:AMENDMENT
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3. OTHER,,,_,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Radiation Protection Of ficer.. s'
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RECEIVEDw si>
JUL 2 7 'l992 O t%t5Lf% v j p2 REG)ON IIIa
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| 614 LUDINGTON STREET, ESCANABA. MICHIGAN 49929 * 906 7891511'
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July 23, 1992
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U. S. Nuclear Reg ulat ory Commi s sion , Region IIIHaterials Licensing Section
I 799 Roosevel t RoadGlen Ell yn , Illiriois 60137
f RE: Amendment to Li cense # 21-26010-01!
|Dear Sir:
This is a request to amend our current license ( f 21 -2 6010-01 ) .
Enclo sed is the c an pleted NRC fo rm 313. Itemized chartes are as f ollo ws :
ltem 2 -- Address change to 113 South 10th Street
item 3 Address charge t o 113 South 10th Street
Item 4 - No change of contact pe r so n f r om original license in fo rm at io n .
Items 5, 6, 7 & 8 - No c ha rge form original license in f o rm a t ion .
It em 9 - Change st.orage area for density gauge to location shown on theenclosed drawirg with address charge to 113 South 10th Street .
I t. e m 10 & 11 - No change fo rm original license in fo rm a tio n .
Item 12 - Ihe 560.00 fee ter amendment to license is enclosed .'
If you need any further information, pl e a se contact me.
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Check No. Le wi s- Va iltM e nc o6r tN +A S N .y d ' 2 A I.-- Radfe[lon frotection OfficerArnou nt .
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APPROVf D BY Ou3il 44 r ,
*R JJ. 31. )4 3440 013010 Gt74 o APPLICArlON FOR M ATERIAL LICENSE i.P e 3).,n .-a .
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SF[ TH( APPHOPRtATE l.tCtN50 APPLICAllON GulOf f OH dei Allt0 INSIRUCilONS F OR ChPLE11NG APPLICATION. $t NO TWO COPIESINST NucitONOF TH( [NilHE COMPLETtD APPLICAT100 YO THE NRC OF FlCE SPEClFltD Bt LOW.
FtOf R AL A44NCats Fil4 APPLICAf tOest WITH: IF YOU ARE LOCAf tO IN
U S teUCLE AR Rf GULATOHV COMMISSION IL UNOll. INDI A NA $OW A, M8C6tlG A N, MINNf 50T A, MtEEOUR1, OMIO, OROtVISION OF FUf.L CYCL 4 ANU MAYE HlAL SA Ff TV, NM53 Fil5 CON 51N, $ E NO APPL IC A T SUNI 70WASHINGTON,0C )@$$
U S NUCL E AR REGULATOHY COMMISSION, fif GION IHM L OTHt R PiilSONS Plt 8 APPUCAflONS AS FOLLOWS,IF VOU ARE M ATE RtALS UCE N$1NG ff aflONLOCATEDIN: hl9 ROOStVELT ROAD
GLEN (LLYk, el 80137CONZECTICtFT. OtLAW ARE. Ol5T RICT OF COLUMtsl A, MAlest, M AR vL AND,MASEACHU$1TT1, NEW Jt Rat Y, NEW YORE, PE NN$YLV ant A, WHOOG 15L ANO, AR K A8#5AS. COL OR AtP WIO, k ANSAS. LOU 4SI ANA, MONT ANA, N E 5R ASE A,OR YB RMONT, SENO APPLICAY SONS 10; Ntw ME RICO. NOR TH OAmDT A, OKLAHOMA, SOUTH DAKOf A, TE RAS, UT AH,
OR WYOMING, $(NO APPLl(.AYlONS TO.U.S NUCLE AR FIFOUL A TOR v COMMitSION, REGION 4NUCL( AR MA1t RI AL $ECTION G U.S NUCLE AR RE OULHTORY COMM11380N. RE GION dV$.11 PARE AVf Mut MATf RI AL R AOIATIOct PROTICTION SECYlONKING OP PHUSSI A. PA 19406 Gil RY AN PLAZA ORf ((,5UITE 1000
A84LINGT ON. T X 760'.1ALAC AMA, PLORIOA, Gt ORGtA, & E NTUCK F, MISSitS6 ppt. NOR T H CAROUN A,PUE RTO M6CO, SOUTH CAROUNA, T ENNT$48 t, VlRQ5NSA, VIRQaN ISL.ANOS. OR AL ASK A, AR120N A, CA 6IFORN4 A, MAR All, ht V ADA, OR6OON, WASHINGTON,NEST VIRGINIA, SENO APPLICATIONS 70; ANO U E. TiHRITORit& ANO POSSESS 10N5 fN TH( PACIF IC,5tNO APPLICAflONS
10.U S NUCLE AN REGULATORY COMM41slON. REGION 11MATE RI A L R AOIATION PFtOf tCTIO*I SLCTION U S NUCLE AR REGULATORY COMMITS 40N RE GION V101 bARIETT A FIRE E T,50lT E 2900 MATE RI AL R ADI A T ION PROT ECTION SECTIONATL ANTA, GA 30323 1450 M AS4tA L ANI., $UIT E 210
W ALNUT CRitk, CA 94S%
PERSONS LOCAf t0 IN AGRitMf MT ST ATES $ENO APPLICAYlON1 TO THE U S GdVCI E AR REQULATORY COMM*fAiON ONLY if THEY WlSH TO POG$ESS ANO USE 44CtNSt 0 MATERIALIN 8T AT4S SUBJiCT TO U.5, NUCLE AR REGULATORY COMMi&5 ION JUR1801CTION
THl415 AN APPLICATION FOR (Caisce asenwree#s deem / 2. NAME AND MAltMNG ADOMESA OF APPUCANT findwsMle Codv/
A. low UC.Ns.
7 21-26010-01 Bittner Engineering, Inc.. AMENOMENT TO UCENu NUM.En 113 South 10th Street] C. MENEWAt OF uCrNu Noma *R Escanaba, Michigan 49829
{3. ADDHtsstE51WHE RE UCENSEO MATEHIAL WILL Bt USED OR POSSE 54E0
Bittner Engineering, Inc.113 South 10th StreetEscanabal MI 49829 and at temporary job sites throughout the U. S. subject to NRC
ity""4 NAME OF PER$0N TO BE CONTACTED ABOUT THIS APPLICAllON T& 1 PHONE NUMBER ''''V'
Dennis B. Bittner, P. E. 906-789-1511SUCulT ITfM5 5 THROUGH 11 ON 8% e it** PAPER, THE TYPt ANO SCOPE OF INFORMATION TO RE PHO*/lOf 0 lS OESCR10ED IN THE LlCENSE APPUCATION OUIDE.
6. RAOlOACTIVE MATERIALe, E homent end meet muMWer, %. Sh8N%48 #*El/GF DhyMel Igym, $n44 4. arenmum emount $ PURFO$E{51 FOR WHICH LICEN$EO MATERI AL WILL DE USED.wrMeh welH lie poses 1.ed et say one linee
1 INOlVfDUAUS) RESPONSISLE FOR R AoIATION 4AFETY PROGR AM AND THEIRE TFLAtNING FOR INDIVIOUALS VQRe ING IN OR FRf 0 VENTING RESTRICTEO ARE AS.TRAINING AND $MPER6ENCE
9. FACILITitS AkO kQUIPMENT. 10 PLADI ATION S As .T Y PROGR AM
s 12 txt N$t t * E E$ s5ee ID C9 9t Iltl end $ertoon D M Jtt11. WA!.TT MApeAGEMFNT. 4 *1 lAMOUNT f, rgVV.nn
| E NCLOSE D $FIE CATEGORY IU VV
13. CERTIFICATION (4dwat avfempetassf ey app 4ce.f/ THE APPLICANT UseO(RSTANOS THAT ALL sT ATEMENTS AND Hf PRESENT ATIONS MADE |N THl$ APPLICATSON AREalNOING UPON THE APPLICANT.THE APPLICANT AND ANY OFFICIAL txECUTINGTH43 CERTlFICATION ON S(H ALF OF THE APPLICANT,NAMEO IN ITEM ?. CE84TIFY THAT THIS APPUCATION l$PREPAREO IN CONFORMITY WITH TITLt 10. COOT OF FEDERAL REGULATIONS. PARTS 30,32,13,34,35, ANO 40 AND THAT ALL INFORMATION CONT AINEO H(R(IPr
| la TRVE AND CORRECT TO THE SEKT Os THEIR kNOWLEOGG AND SEllEP.
[ W Arts 44NG la u S C. 5ECTION 1001 ACT OP JUNt ?S.1944. 42 3 TAT 749 MAKElli A CRIMINAL OFFENSE TO MAm t A WILLFULLY F AL$4 5TATEMENT OM MEPRESEN1PTIONTO ANyOjeARTMENT OR AGENCY OF THE UNtTED ST ATE 5 AS TO ANY MATTER WITHIN SYS JURt3OICTION
$3GNATURfj ER TTPVIPfE 00 TYPED /PRINTEO NAME TITLE DATE
L.~ k /A [ b| Dennis Bittner President July 22,1992,
: , ,. _ .... . .. -u n m eTs S NUMseR OF tuftO,Eas (rew Aw e WOutO vou se WiluNo TO FUUN15H C05T 1NFOHMATION Gener eabor startaavas/;
| g 1750K S IM 4 AU **"*#***'V****'#'*'*"'''d'''"*''''''#-
.f OrO5_(O .NRC RE_GUL_ATIONS TH A,T_M A Y AF FEC..T YOUT IN_RC ro_FudeWo*M ae.rmMgON TME ECONOMIC 6MPACT OF CURRENT NRC RtGULATIONS OR ANY FUTURE |Pil
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PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. 552a(e)(31. enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93 579),the follow-ing statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form313. This information is maintained in a system of records designated as NRC 3 and described at 40 Federal Register 45334(October 1,1975).
1. AUTHORITY: Sections 81 aa 1161(b) of the Atomic Energy Act of 1954, as .wadeo (42 U.S.C. 2111 and 2201(b)).
2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFRParts 30,32,33,34,35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendmentthereof.
3. ROUTINE USES: The information may be (a) provided to State health departments for thelc information and use;and (b) provided to Federat, State, and local health officials and other persons in the event of incident or exposure,for their information, investigation, and protection of the public health and safety. The information may also be dis-closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potentialviolation of law and in the course of an administrative or judicial proceeding. In addition, this information may be trans-ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or toan appropriate Federal agency to the extent relevant and necessary for thtt agency's decision about you.
4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND 9FCF':T ON INDIVIDUAL OF NOT PROVID-|NG INFORMATION: Disclosure of the requested information is volurir i If the requested informatiori is rot furn.ished, however, the application for radioactive material license, or amendmNt thereof, will not be processed. A requestthat information be held from public inspection must be in accordance wit:. the proveim of 10 CFR 2.790. Withhold-ing from public inspection shall not affect the right, if any, of persons properly and directly ancerned need to inspectthe document.
5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commission
Director, Division of Fuel Cycle and Material SafetyOffice of Nuclear Material Safety and SafeguardsWashingtor.. D.C. 20E55
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NRC FORM 313.
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SEP 2 81992Bittner Engineering Inc.ATTN: Lewis Vailliencourt
Radiation Safety Officer113 South 10th StreetEscanaba, MI 49829
Dear Mr. Vailliencourt:
Enclosed is Amend,aent No. 01 to your NRC License No. 21-26010-01 in accordancewith your request.
Please review the enclosed document carefully and be sure that you understandall conditions. You must conduct your program involving radioactive materialsin accordance with the conditions of your NRC license, representations made inyour license application, and NRC regulations. In particular, note that youmust:
1. Operate in accordance with NRC regulations 10 CFR Part 19, " Notices,Instructions and Reports to Workers; Inspections," 10 CFR Part 20," Standards for Protection Against Radiation," and other applicableregulations.
2, Possess radioactive material only in the quantity and form indicatedin your license.
3. Use radioactive material only for the purpose (s) indicated in yourlicense.
4. Notify NRC in writing of any change in mailing address.
5. Request and obtain appropriate amendment if you plan to change ownershipof your organization, change locations of radioactive material, or makeany other changes in your facility or program which are contrary to yourlicense conditions or representations made in your license applicationand any supplemental correspondente with NRC. Any amendment requestshould be accompanied ay the appropriate-fee specified in 10 CFRPart 170.
6. Submit a complete renewal application with proper fee or terminationrequest at least 30 days before the expiration date on your license.You will receive a reminder notice approximately 90 days before theexpiration date. Possession of radioactive material after your licenseexpires is a violation of NRC regulations.
7. Request termwation of your license if you plan to permanentlydiscontinue activities involving radioactive material prior toyour expiration date.
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.SEP 2 81992Bittner Engineering, Inc. -2-
You will be periodically inspected by NRC. Failure to conduct your program inaccordance with NRC regulations, license conditions, and representations inyour license application will result in enforcement action against you.inaccordance with the General Policy and Procedures for NRC- Enforcement Actions,10 CFR Part 2, Appendix C.
If you have-any questions or require clarification of. any of the above stated -information, contact us at (708) 790-5625.
Sincerely, .
Original Signed ByKevin G. NullMaterials Licensing Section
t
Enclosure: Amendment No. 01
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Null /dg-09/ /92
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Bittner Engineering, c.
Attn Lewis VailliencourtRadiation Protection Officer
113 South 10th StreetE s'c an ab a , MI 49829 kDO l 7 l337'
Gentlemen
This refers to your application dated July 22, 1992, for an amendment toMaterials License 21-26010-01.
We received your check for $60. Your request, however, is subject to anamendment fee of S380 as specified in fee Category 3P of $170.31, 10 CFR 170,which went into effect August 9, 1991. A copy of the July 10, 1991, FederalBeaister notice regarding the revisions to the Commission's license and annualfee regulations (10 CFR 170 and 10 CFR 171) is enclosed.
Please note that effective August 9, 1991, materials licensees are alsosubject to the annual fees specified in revised 10 CFR 171. Payment of theadditional $320 fee should be made to the U.S. Nuclear Regulatory Commicsionand mailed to the following address
--
U.S. Nuclear Regulatory CommissionATTN: Cheryl PhillipsLicense Fee and Debt Collection Branch, OC/DAFMail Stop MNBB 4503Washington, DC 20555
Your application will be processed by the Region III Licensing staff locatedat 799 Roosevelt Road, Glen Ellyn, Illinois 60137. The fee, however, isrequired prior to issuance of the amendment. When submitting the additionalfee, please refer to CONTROL NUMBER 393753.
If we do not receive a reply from you within 30 calendar days from the date etthis letter, we shall assume that you do not wish to pursue your applicationand will void this action.
Sincerely,
/S/Cheryl PhillipsLicense Fee and Debt Collection BranchDivision of Accounting and Finance _
Office of the Controller
Enclosure:July 10, 1991, Federal Recister notice
cc: Region III
DISTRIBUTIONPending Fee FileOC/DAF R/FLFDCB R/F (2) IkAOFFICE: OC/LFDCB /'[fOC/ CB OC/LFDCBNAMEt REJacques CPh lips KMessier
9 / /3/ cfj- / / y/g/DATE:
19\B: ADD-KS4\B:bei.mer
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Bittner Engineering, Inc.Attn Lewis Vailliencourt
Radiation Protection Officer113 South loth StreetEscanaba, MI 49829 ,nj,- <
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Gentlemen:
This refers to your application dated July 2 1992f f or3 9ngmendment toMaterials Licenso 21-26010-01. A iW I'
We received your check for $60. Your request however, is subject to any
fee of $380 as specified in fee Cat'6go,r,y'g3Pfo.f'Sl?O.31, 10 CFR 170,amendment.
which went into offeet August 9, 1991. A copy Vf tthe'"Jaly 10, 1991, federalRe_gister notice regarding the revisions to the Commission's license and annualfee regulations (10 CFR 170 and 10 CFR 171) is enclosed.
Please note that effective August 9, 1991, materials licensees are alsosubject to the annual fees specifLed in revised 10 CPR 171. Payment of theadditional S320 fee should be made to the U.S. Nuclear Regulatory-Commissionand mailed to the following address:
U.S. Nuclear Regulatory CommissionATTNs Cheryl PhillipsLicense Fee and Debt Collection Branch, OC/DAFMail Stop MNBB 4503Washington, DC 20555
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Your application will be processed by the Region III Licensing staff located-at 799 Roosevelt Road, Glen Ellyn; Illinois 60137. The fee, however, isrequired prior to issuance of the amendment. When submitting the additionalfee, please refer to CONTROL NUMBER 393753.
#i If we do not receive a reply from you within 30 calendar days from the date.of| this letter, we shall assume that you do not wish to pursue your application
and will void this action.
Sincerely, b /
V-9t; 7wChery $ lipsLicense Fee and Debt Collection BranchDivision of Accounting and Finance
,
Office of the Controller i
Enclosure:July 10, 1991, Federal Recrister notice
cc: Region III |
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